State of the ACT Evidence

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ACT is committed to a high standard of empirical evaluation. This includes not just controlled assessment and evaluations of outcomes but also the specification and evaluation moderations and of the putative processes of change. Furthermore, we also seek to understand the links between these processes of change and basic functional behavioral principles, including those drawn from RFT.

One web page is unable to collect together the growing evidence for all of the above areas at one time point or to keep it up to date going forward. More modestly, the three sections below aim to provide information on:

1. Organizations that describe ACT, or areas of ACT, as evidence based
2. Links to peer reviewed assessments of the ACT evidence base
3. Snapshots of the ACT RCT evidence base (a list of actual randomized controlled trials can be found at another page: https://contextualscience.org/ACT_Randomized_Controlled_Trials; a list of mediational studies can be found at

This page will be updated approximately once every six months. Date of late update: January 2019. If you are aware of missing data, please contact the ACBS staff: acbsstaff@contextualscience.org

1. Organizations that describe ACT, or areas of ACT, as evidence based:

A number of different organizations, external to ACBS, have stated that ACT is empirically supported in certain areas or as a whole according to their standards. These include:

i. American Psychological Association, Society of Clinical Psychology (Div. 12), Research Supported Psychological Treatments:

Chronic Pain - Strong Research Support
Depression - Modest Research Support
Mixed anxiety - Modest Research Support
Obsessive-Compulsive Disorder - Modest Research Support
Psychosis - Modest Research Support
For more information on what the "modest" and "strong" labels mean, click here

ii. SAMHSA's National Registry of Evidence-based Programs and Practices, ACT, last review July 2010.

2. Links to peer reviewed assessments of the ACT evidence base:

Below is a list of meta-analyses, systematic or narrative reviews of the ACT evidence base, either overall or in specific areas. They are presented in reverse chronological order, by year of publication.

The cummulative number of meta-analyses of the ACT literature is growing rapidly and will likely hit 50 by the end of 2019 (a graphic of the growth is attached as a JPEG file at the bottom of this page)

In Press

45. Yıldız, E. (in press). The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials. Perspectives in Psychiatric Care.
DOI: 10.1111/ppc.12396
Full Text: Available Through DOI

44. Wilson, A.C., Mackintosh, K., Power, K. & Chan, S. W. Y. (in press). Effectiveness of self-compassion related therapies: A systematic review and meta-analysis. Mindfulness.
DOI: 10.1007/s12671-018-1037-6
Full Text: Available Through DOI

2019

43. Kelson, J, Rollin, A, Ridout, B, & Campbell, A. (2019). Internet-delivered Acceptance and Commitment Therapy for anxiety treatment: Systematic review. Journal of Medical Internet Research, 21(1):e12530
DOI: 10.2196/jmir.12530
Full Text: Available Through DOI

2018

42. Kishita, N., Hammond, L., Dietrich, C., & Mioshi, E. (2018). Which interventions work for dementia family carers?: An updated systematic review of randomized controlled trials of carer interventions. International Psychogeriatrics, 30(11), 1679-1696.
DOI: 10.1017/S1041610218000947
Full Text: Available Through DOI

41. Reeve, A., Tickle, A., & Moghaddam, N. (2018). Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis. Mental Health Review Journal, 23 (3), 131-155.
DOI: 10.1108/MHRJ-11-2017-0052
Full Text: Available Through DOI

40. Lee, E. K., & Song, M. K. (2018). Effectiveness of ACT-based group counseling for depression and anxiety : A meta-analysis. The Korean Journal of Counseling and Psychotherapy, 30(3), 635-661.
DOI: 10.23844/kjcp.2018.08.30.3.635
Full Text: Available Through DOI [Manuscript Not in English]
Corresponding Author: Mikyoung Song

39. Schütze, R. Rees, C., Smith, A., Alater, H., Campbell, J. M., & O'Sullivan, P. (2018). How can we best reduce pain catastrophizing in adults with chronic noncancer pain? A systematic review and meta-analysis. The Journal of Pain, 19, 233-256.
DOI: 10.1016/j.jpain.2017.09.010
Full Text: Available Through DOI

38. Linardon, J., Gleeson, J., Yap, K., Murphy, K. & Brennan, L. (2018). Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: Implications for eating disorder prevention. Cognitive Behaviour Therapy, 48(1), 15-38.
DOI: 10.1080/16506073.2018.1517389
Full Text: Available Through DOI

37. Ong, C. W., Lee, E. B. & Twohig, M. P. (2018). A meta-analysis of dropout rates in acceptance and commitment therapy. Behaviour Research and Therapy, 104, 14-33.
DOI: 10.1016/j.brat.2018.02.004
Full Text: Available Through DOI

36. Serfaty, S., Gale, G., Beadman, M., Froeliger, B., & Sunjeev, S. K. (2018). Mindfulness, acceptance and defusion strategies in smokers: A systematic review of laboratory studies. Mindfulness, 9, 44-58.
DOI: 10.1007/s12671-017-0767-1
Full Text: Available Through DOI

35. Collins, R. N., & Kishita, N. (2018). The effectiveness of mindfulness- and acceptance-based interventions for informal caregivers of people with dementia: A meta-analysis. The Gerontologist, gny024.
DOI: 10.1093/geront/gny024
Full Text: Available Through DOI

34. Maynard, B. R., Wilson, A. N., Labuzienski, E., & Whiting, S. W. (2018). Mindfulness-based approaches in the treatment of disordered gambling: A systematic review and meta-analysis. Research on Social Work Practice, 28, 348-362.
DOI: 10.1177/1049731515606977
Full Text: Available Through DOI

33. Feliu-Soler, A., Cebolla, A., McCracken, L. M., D’Amico, F., Knapp, M., López-Montoyo, A., García-Campayo, J., Soler, J., Baños, R. M., Pérez-Aranda, A., Andrés-Rodriguez, L., Rubio-Valera, M., & Luciano, J. V. (2018). Economic impact of third-wave cognitive behavioral therapies: A systematic review and quality assessment of economic evaluations in randomized controlled trials. Behavior Therapy, 49, 124-147.
DOI: 10.1016/j.beth.2017.07.001
Full Text: Available Through DOI

2017

32. Rudaz, M., Twohig, M.P., Ong, C.W. & Levin, M.E. (2017). Mindfulness and acceptance-based trainings for fostering self-care and reducing stress in mental health professionals: A systematic review. Journal of Contextual Behavioral Science, 6, 380-390
DOI: 10.1016/j.jcbs.2017.10.001
Full Text: Available Through DOI

31. French, K., Golijani-Moghaddam, N., & Schröder, T. (2017). What is the evidence for the efficacy of self-help acceptance and commitment therapy? A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 6, 360-374.
DOI: 10.1016/j.jcbs.2017.08.002
Full Text: Available Through DOI

30. Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatric Clinics of North America, 40, 751-770.
DOI: 10.1016/j.psc.2017.08.009
Full Text: Available Through DOI

29. Rogers, J.M., Ferrari, M., Mosely, K., Lang, C.P., & Brennan, L. (2017). Mindfulness-based interventions for adults who are overweight or obese: A meta-analysis of physical and psychological health outcomes. Obesity Reviews, 18, 51-67.
DOI: 10.1111/obr.12461
Full Text: Available Through DOI

28. Gilpin, H. R., Keyes, A., Stahl, D. R., Greig, R. & McCracken, L. M. (2017). Predictors of treatment outcome in contextual cognitive and behavioral therapies for chronic pain: A systematic review. The Journal of Pain, 18, 1153-1164.
DOI: 10.1016/j.jpain.2017.04.003
Full Text: Available Through DOI

27. Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain: A systematic review and meta-analyses. Clinical Journal of Pain, 33, 552-568.
DOI: 10.1097/AJP.0000000000000425
Full Text: Available Through DOI

26. Noetel, M., Ciarrochi, J., Van Zanden, B., & Lonsdale, C. (2017). Mindfulness and acceptance approaches to sporting performance enhancement: A systematic review. International Review of Sport and Exercise Psychology,.
DOI: 10.1080/1750984X.2017.1387803
Full Text: Available Through DOI

25. Atkins, P. W. B., Ciarrochi, J., Gaudiano, B. A., Bricker, J. B., Donald, J., Rovner, G., Smout, M., Livheim, F., Lundgren, T., & Hayes, S. C. (2017). Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy, 97, 259-272.
DOI: 10.1016/j.brat.2017.05.016
Full Text: Available Through DOI

24. Simpson, P. A., Mars, T., & Esteves, J. E. (2017). A systematic review of randomised controlled trials using acceptance and commitment therapy as an intervention in the management of non-malignant, chronic pain in adults. International Journal of Osteopathic Medicine, 24, 18-31.
DOI: 10.1016/j.ijosm.2017.03.001
Full Text: Available Through DOI

23. Lønfeldt, N. N., Silverman, W. K., & Esbjørn, B. H. (2017). A systematic review and meta-analysis of the association between third-wave cognitive constructs and youth anxiety. International Journal of Cognitive Therapy, 10, 115-137.
DOI: 10.1521/ijct.2017.10.2.115
Full Text: Available Through DOI

2016

22. Tonarelli, S. B., Pasillas, R., Alvarado, L., Dwivedi, A., & Cancellare, A. (2016). Acceptance and commitment therapy compared to treatment as usual in psychosis: A systematic review and meta-analysis. Journal of Psychiatry, 19, 366.
DOI: 10.4172/2378-5756.1000366
Full Text: Available Through DOI

21. Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of Affective Disorders, 190, 551-565.
DOI: 10.1016/j.jad.2015.10.053
Full Text: Available Through DOI

20. Brown, M., Glendenning, A., Hoon, A. E. & John, A. (2016). Effectiveness of web-delivered acceptance and commitment therapy in relation to mental health and well-being: A systematic review and meta-analysis. Journal of Medical Internet Research, 18(8), e221.
DOI: DOI Error
Full Text: Journal Website

19. Graham, C. D., Gouick, J., Krahé, C., & Gillanders, D. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review, 46, 46-58.
DOI: 10.1016/j.cpr.2016.04.009
Full Text: Available Through DOI

18. Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T. & Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review. Cognitive Behaviour Therapy, 45, 5-31.
DOI: 10.1080/16506073.2015.1098724
Full Text: Available Through DOI

2015

17. Ducasse, D., & Fond, G. (2015). La thérapie d’acceptation et d’engagement [Acceptance and commitment therapy. L'Encéphale, 41, 1-9.
DOI: 10.1016/j.encep.2013.04.017
Full Text: Available Through DOI

16. Lee, E. B., An, W., Levin, M. E., & Twohig, M. P. (2015). An initial meta-analysis of acceptance and commitment therapy for treating substance use disorders. Drug and Alcohol Dependence, 155, 1-7.
DOI: 10.1016/j.drugalcdep.2015.08.004
Full Text: Available Through DOI

15. Godfrey, K. M., Gallo, L. C., & Afari, N. (2015). Mindfulness-based interventions for binge eating: A systematic review and meta-analysis. Journal of Behavioral Medicine, 38, 348-362.
DOI: 10.1007/s10865-014-9610-5
Full Text: Available Through DOI

14. A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(30), 30-36.
DOI: 10.1159/000365764
Full Text: Available Through DOI

2014

13. Bluett, E.J., Homan, K.J., Morrison, K.L., Levin, M.E. & Twohig, M.P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 6, 612-624.
DOI: 10.1016/j.janxdis.2014.06.008
Full Text: Available Through DOI

12. Cavanagh, K., Strauss, C., Forder, L., & Jones, F. (2014). Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review, 34, 118-129.
DOI: 10.1016/j.cpr.2014.01.001
Full Text: Available Through DOI

11. Öst, L. G. (2014). The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy, 61, 105-121.
DOI: 10.1016/j.brat.2014.07.018
Full Text: Available Through DOI
Note: See review above: Atkins et al., 2017

2013

10. Swain, J., Hancock, K., Hainsworth, C., & Bowman, J. (2013). Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clinical Psychology Review, 33, 965-978.
DOI: 10.1016/j.cpr.2013.07.002
Full Text: Available Through DOI

2012

9. Klainin-Yobas, P., Cho, M. A. A., & Creedy, D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis. International Journal of Nursing Studies, 49, 109-121.
DOI: 10.1016/j.ijnurstu.2011.08.014
Full Text: Available Through DOI

8. Smout, M. F., Hayes, L., Atkins, P. W. B., Klausen, J., & Duguid, J. E. (2012). The empirically supported status of acceptance and commitment therapy: An update. Clinical Psychologist, 16, 97-109.
DOI: 10.1111/j.1742-9552.2012.00051.x
Full Text: ACBS Website

2011

7. Soo, C., Tate, R. L., & Lane-Brown, A. (2011). A systematic review of acceptance and commitment therapy (ACT) for managing anxiety: Applicability for people with acquired brain injury. Brain Impairment, 12, 54-70.
DOI: 10.1375/brim.12.1.54
Full Text: Available Through DOI

6. Veehof, M. M., Oskam, M., Schreurs, K. M. G., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152, 533-542.
DOI: 10.1016/j.pain.2010.11.002
Full Text: Available Through DOI

2010

5. Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10, 125-162.
DOI: No DOI
Full Text: ACBS Website

2009

4. Powers, M. B., Zum Vörde Sive Vörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78, 73-80.
DOI: 10.1159/000190790
Full Text: ACBS Website

3. Gaudiano, B. A. (2009). Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching apples with oranges? Behaviour Research and Therapy, 47, 1066-1070.
DOI: 10.1016/j.brat.2009.07.020
Full Text: ACBS Website

2008

2. Öst, L. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296-321.
DOI: 10.1016/j.brat.2007.12.005
Full Text: ACBS Website

2006

1. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
DOI: 10.1016/j.brat.2005.06.006
Full Text: ACBS Website

3. Mediational analyses

ACT is a process-oriented approach and the list of studies testing mediation or moderation is quite large. As of Spring 2016 we were aware of approximately 45 mediational studies. This list is rapidly growing. A partial list can be found here (a child page to this webpage).

4. Qualitative Research

After the first three RCTs in the early 1980's ACT research turned toward transcript analysis and qualitative research. Examples are the first ACT dissertations done at the Univeristy of Nevada by Sue McCurry and Durriyah Khorakiwala. This work in turn lead to the first item set for the AAQ, and to the commonly used ACT adherence measures, in addition to the protocol described in the first ACT book in 1999.

Qualitative work is hard to do but it has continued throughout the ACT research program. Examples can be found here (a child page to this webpage). If you find any more send them to ACBS staff to add to the list.

5. Snapshots of the ACT RCT evidence base:

As of May 2019, there are 304 randomized controlled trials (RCTs) of ACT published. Details of each of these studies, along with links to the original research articles, can be found here (a child page to this webpage). Below, we provide a snapshot of this ACT RCT evidence-base, summarizing clinical areas in order of the number of published RCTs. This list is current as of May 2019. It is, of course, acknowledged that evidence from RCTs is only one part of evidence-based practice, and for some questions and issues it is arguably not the most important.

Area: Number of studies: RCT page study number(s):
Anxiety 32 5, 19, 22, 37, 44, 48, 60, 63, 64, 88, 97, 114, 135, 137, 139, 148, 158, 168, 169, 176, 192, 199, 208, 215, 227, 234, 235, 238, 247, 257, 260, 284
Pain 30 9, 14, 20, 24, 28, 31, 39, 48, 53, 56, 66, 69, 74, 87, 94, 108, 126, 130, 133, 146, 170, 171, 185, 239, 240, 251, 270, 278, 293, 295
Depression 28 1, 2, 26, 41, 46, 50, 62, 67, 68, 79, 92, 95, 122, 129, 134, 141, 150, 154, 174, 201, 202, 206, 223, 233, 252, 255, 268, 265
Various 28 17, 32, 33, 40, 49, 52, 100, 109, 132, 138, 145, 149, 163, 181, 182, 207, 210, 218, 228, 231, 232, 256, 271, 283, 285, 289, 290, 291, 292
Stress 16 3, 34, 35, 45, 65, 80, 83, 84, 85, 111, 113, 123, 143, 147, 230, 276
Substance Abuse 14 6, 29, 54, 59, 89, 106, 112, 125, 127, 161, 209, 254, 262, 263
Weight Loss 13 25, 27, 43, 71, 99, 121, 157, 164, 165, 184, 216, 219, 286
Social Anxiety 13 78, 81, 110, 115, 117, 118, 119, 151, 173, 178, 246, 261, 264
Cancer 11 15, 58, 82, 93, 104, 167, 193, 224, 253, 275, 288
Smoking 8 8, 42, 72, 86, 101, 102, 155, 220
Eating Disorders 6 30, 57, 61, 77, 177, 198
Multiple Sclerosis 6 162, 189, 211, 213, 245, 267
Obsessive-Compulsive Disorder 6 28, 36, 90, 214, 225, 244
Parenting 6 98, 103, 128, 229, 243, 259
Psychosis 6 4, 13, 47, 180, 202, 269
Quality of Life 6 105, 175, 186, 195, 236, 249
Couple / Marital Relations 5 179, 188, 194, 213, 268
Diabetes 5 18, 96, 160, 197, 205
Stigma 5 7, 16, 107, 131, 166
Exercise 4 140, 142, 144, 156
Fibromyalgia 4 75, 76, 116, 241
Training 4 21, 24, 159, 287
Occupational Outcomes 3 183, 222, 281
Prevention 3 91, 153, 273
Procrastination 3 124, 204, 266
Sleep 3 221, 226, 292
Borderline Personality Disorder 2 12, 55
Bowel Diseases 2 272, 274
Epilepsy 2 11, 23
Health Behaviors 2 217, 248
Prevention 2 88, 250
Tinnitus 2 38, 51
Trichotillomania 2 10, 237
Aggression 1 136
Asthma 1 282
Attention 1 191
Confidence 1 197
Gambling 1 172
HIV 1 190
Pornography 1 152
Psychological Flexibility 1 187
Skill Coaching 1 280
Somatic Syndromes 1 279
Stroke 1 277
Suicide 1 242
Trauma 1 120
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